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2023 HSR&D/QUERI National Conference Abstract

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4079 — Design and tailoring of quality dashboards to support the implementation of evidence-based preventive care services for women Veterans

Lead/Presenter: Catherine Chanfreau,  Resource Center - VINCI
All Authors: Chanfreau C (VINCI, Salt Lake City & Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles), Bean-Mayberry B (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles & UCLA David Geffen School of Medicine) Finley EP (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Than CT (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Clair K (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Doan Q (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles Knight CM (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles) Moin T (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles & UCLA David Geffen School of Medicine) Hamilton A (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles & UCLA David Geffen School of Medicine) Farmer MM (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles)

Objectives:
Quality dashboards and performance measures are essential components of learning health care systems to assess processes, quality of care, and patient outcomes. However, a gap exists in measures to inform preventive care for women Veterans outside of gender-specific services (e.g., cancer screenings). We describe here the development of women-tailored quality dashboards to support EMPOWER 2.0, a VA QUERI-funded implementation trial testing two strategies (Replicating Effective Programs and Evidence-Based Quality Improvement) for the delivery of three virtual evidence-based practices (EBP) focused on preventive care for women Veterans at 20 sites. The goals of the dashboards are to inform sites on the characteristics of their patient populations, provide women-specific population health measures, and facilitate the tracking of implementation efforts.

Methods:
Dashboard design was informed through a series of discussions amongst the implementation team with attention to purpose and audience; we also conducted pre-implementation interviews at the sites to learn about user experience with performance metrics and identify data-focused tools to guide implementation. We collected and integrated data for the cohort seen at each site using multiple sources: (1) we developed procedures to extract and transform VA electronic health record (EHR); (2) we obtained data and/or code from national partner offices to link VA performance metrics to the cohort and produce women-specific metrics ; and (3) we collected data on EBP delivery from vendors providing services. The dashboards reporting patient population statistics and performance metrics are published through a Power BI App, which allows access to a wide audience of stakeholders while limiting the user view to their site population. This restriction reduces potential contamination across sites receiving different implementation strategies. Performance metrics are displayed graphically with a set of dynamic filters. Reports are refreshed monthly.

Results:
Our cohort includes all women with an active PACT team enrollment at participating sites (range: 1,027-21,740 women per site). The quality dashboards provide insights on key population characteristics (age groups, race and ethnicity, urban/rural residence, weight status), and users can apply dynamic filters in the report to focus on specific patient subgroups. Measures to support population management include trends in patient weights, performance metrics for depression screening and participation in MOVE! and other Whole Health services. A report showing overall and monthly referrals and participation in EBPs provides implementation feedback.

Implications:
We designed gender-specific quality dashboards to facilitate population health management and EBP implementation for women Veterans. Feedback from sites on these tools will help assess how to improve their format, content, and user experience, and assess dashboard utility as an implementation strategy to support women’s health EBPs.

Impacts:
We have successfully incorporated and tailored data from different sources (VA EHR, performance metrics, vendor data) into one dashboard for the sites to use in their implementation, a task which most sites lack resources to perform alone. The dashboards allow sites to gain access to a comprehensive overview of population health, identify gaps in existing care, and continuously evaluate whether implementation efforts are working as expected while monitoring potential population health impacts from each EBP.